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Chapter 7: TBE in special situations

The incubation period in organ-transplanted gestation. Diagnosis at that time was
patients was longer than reported in tick- confirmed using a neutralization test;
infected, TBE patients with no underlying however, no detailed information on the
disease. The ICH does not show the typical diagnostic confirmation (e.g. fourfold titre
findings of TBE-infection in cerebrospinal fluid. increase etc.) is given. Two of the three
In one patient with immuno-suppressive females showed a severe form of TBE
treatment for non-Hodgkin lymphoma about 1 (myelitis, encephalomyelitis). One pregnant
year earlier, a life-threatening form of severe female showed only a febrile course of the
TBE was observed. It is, however, unclear disease. All three women survived without
whether the immuno-suppression was the neurological sequelae. The outcome in the
reason for the severe form. offspring of the two pregnant females with
TBE early during pregnancy was unfortunate
Therefore, in immunosuppressed patients (see Table 2). No serological information is
with a risk of TBE infection the immuno- provided from any of the three neonates.
genicity of TBE vaccination should be tested
by neutralization test. Vaccinated ICH-patients In a few more cases described in the Czech
who had received 3 primary TBE vaccine doses Republic and in Austria in the 1950s and early
before immunosuppressive therapy was 1960s no specific serological TBE diagnosis
started and with continuing risk of TBE infec- could be made, but the diagnosis was made
tion should be tested after the immuno- on the basis of clinical symptoms and the
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suppression was stopped and they should be epidemiological situation. However, in all
re-vaccinated in case no neutralizing anti- cases the newborns showed neither any signs
bodies are detected. of infection nor did they develop any clinically
overt neurological acute or persistent symp-

toms.
TBE in pregnancy
In 2018 two additional cases of TBE during
pregnancy were brought to the attention of
Pregnancy is another situation with (physio- the author of this chapter (manuscript in
logical) immunosuppression (for review see preparation). One woman was in week 20 of
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Koutis et al., 2014 ) and it may also result in gestation when she developed a very severe
more severe forms of TBE. Although TBE is form of TBE requiring mechanical ventilation
endemic throughout most of Europe and Asia for several days. She gave birth to a healthy
with high incidence rates in some regions, child. Serological testing at the time of birth
there are only few data on TBE during
and 3 and 6 months later as well as virologic
pregnancy and its effect on the human testing of mother and baby showed that
offspring. The only available reference is one
antibodies of the mother were diaplacentally
report on the occurrence of three TBE cases transferred to the baby and could be detected
during pregnancy in the former German at birth; however, the infant never developed
10
Democratic Republic. Three pregnant fe- IgM as evidence of active infection and IgG
males developed TBE after drinking contam- antibodies significantly decreased during the
inated milk and developed a clinically overt first months of life.
TBE.
In the case of a twin pregnancy in Sweden
Two of the three cases described developed
reported in 2018 (manuscript in preparation)
TBE during the early phase of pregnancy the mother developed severe clinical TBE
(week 8 to 10 of gestation). The third woman
(encephalitis). Symptoms started in week 30
showed first clinical signs of TBE in week 24 of

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